Harms of unsuccessful donation after circulatory death: An exploratory study

Abstract

While donation after circulatory death (DCD) has expanded options for organ donation, many who wish to donate are still unable to do so. We conducted face-to-face interviews with family members (N = 15) who had direct experience with unsuccessful DCD and 5 focus groups with professionals involved in the donation process. We used qualitative content analysis to characterize the harms of nondonation as perceived by participants. Participants reported a broad spectrum of harms affecting organ recipients, donors, and donor families. Harms included waste of precious life-giving organs and hospital resources, inability to honor the donor's memory and character, and impaired ability for families to make sense of tragedy and cope with loss. Donor families empathized with the initial hope and ultimate despair of potential recipients who must continue their wait on the transplant list. Focus group members reinforced these findings and highlighted the struggle of families to navigate the uncertainty regarding the timing of death during the donation process. While families reported significant harm, many appreciated the donation attempt. These findings highlight the importance of organ donation to donor families and the difficult experiences associated with current processes that could inform development of alternative donation strategies.

The development of a narrative describing the bereavement of families of potential organ donors: A systematic review

“…ethical debates) and were excluded from the present review, leaving 119 sources. While writing up the review, a relevant article was published ( Taylor et al, 2017 ), and this was added giving a total of 120 sources.…”

“…Many families reconcile features of the experience by concluding that life without brain function is not the life they want for their relative ( Long et al, 2006 ) and some consent to donation hoping that the delay between consent and surgery would provide one last chance for recovery ( Manuel et al, 2010 ; Rassin et al, 2005 ). Knowing the time of death is important to families ( Fulton et al, 1977 ; Holtkamp, 1997 ; Northam, 2015 ), and Taylor et al (2017) found that when families had consented to donation after cardiac death (DCD) and their relative did not die within the required timeframe, some family members questioned whether they had given up too soon.…”

Family bereavement: A case study of controlled organ donation after circulatory death

“…An American study found that unsuccessful DCD was associated with a broad spectrum of harms as experienced by family members and confirmed by professionals who cared for them. Despite these harms, many families did not regret attempted donation …”

A mixed-methods study of organ donation in the intensive care unit: 22 actionable practices to improve organ donation

“…This perception is consistent with results from interviews with donor families. 32,33 Participants in the present study considered care of the patient and family an overriding priority and only saw donation as a positive outcome if it was consistent with patient values and preferences. This is a novel observation, but has been hinted at in existing research.…”